Role of duodenography in the diagnosis of blunt duodenal injuries

Background. The differentiation of duodenal perforation from duodenal hemat oma is not always possible with computed tomography (CT). Our diagnostic gu ideline has included duodenography to investigate CT findings of periduoden al fluid or wall thickening. However, the utility of duodenography as a dia gnostic study in blunt abdominal trauma is not defined. We evaluated duoden ography as a diagnostic test in patients with suspected blunt duodenal inju ries (BDIs). Methods. During a 10-year period, 96 patients out of 25,608 trauma admissio ns had CT findings of possible BDI and underwent duodenography. Demographic and clinical data, diagnostic methods, and management were derived from pr ospectively collected data. CT and duodenography studies were reviewed and correlated with surgical findings and outcome. All CT scans were obtained w ith intravenous contrast; oral contrast was used in 32 patients. Duodenogra phy was analyzed using the 2 X 2 method and Bayes theorem. Results: Indications for duodenography included periduodenal fluid without extravasation (76%), abnormal duodenal wall thickening (16%), and retroperi toneal extraluminal gas (5%). Eighty-six duodenography studies were reporte d as normal, six were consistent with hematoma, one was indeterminate, and only three revealed extravasation. Two of these three patients with duodena l perforation had retroperitoneal extraluminal air. Only one patient underw ent exploration on the basis of duodenography. No blunt duodenal perforatio n was diagnosed by CT. Overall, duodenography had sensitivity of 54% and sp ecificity of 98%. For BDIs requiring repair, duodenography sensitivity was only 25%; the false-negative rate was also 25%. Retroperitoneal extralumina l air was a useful sign of duodenal perforation, occurring in two of three patients with BDI and only in one without BDI (p < 0.001). Conclusion Duodenography has a low sensitivity in patients with suspected B DI by CT findings and is of minimal utility in diagnostic evaluation. Retro peritoneal extraluminal air seen on CT is an important sign of BDI requirin g surgical repair.